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Effect of the remuneration system on the general practitioner's choice between surgery consultations and home visits
1Centre for Health Economics, University of York.
Objective:
To assess the influence of the remuneration system, municipality, doctor, and patient characteristics on general practitioners' choices between surgery and home visits.
Design:
Prospective registration of patient contacts during one week for 116 general practitioners (GPs).
Setting:
General practice in rural areas of northern Norway.
Main Outcome Measure:
Type of GP visit (surgery v home visit).
Results:
The estimated home visit rate was 0.14 per person per year. About 7% (range 0-39%) of consultations were home visits. Using multilevel analysis it was found that doctors paid on a "fee for service" basis tended to choose home visits more often than salaried doctors (adjusted odds ratio 1.90, 99% confidence interval 0.98, 3.69), but this was statistically significant for "scheduled" visits only (adjusted OR 4.50, 99% CI 1.67, 12.08). Patients who were older, male, and who were living in areas well served by doctors were more likely to receive home visits.
Conclusion:
In the choice between home visits and surgery consultations, doctors seem to be influenced by the nature of the remuneration when the patient's problem is not acute. Although home visiting is a function of tradition, culture, and organisational characteristics, the study indicates that financial incentives may be used to change behaviour and encourage home visiting.
